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Lee N, Nadeau P, Berjaoui MB, Assad A, Chew B, Penniston K, Bhojani N. Treatment modalities for small-sized urolithiases and their impact on health-related quality of life. Can Urol Assoc J 2024; 18:280-287. [PMID: 38587975 PMCID: PMC11326729 DOI: 10.5489/cuaj.8698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Health-related quality of life (HRQoL) is often reduced in patients with urolithiasis. The objective of this study was to perform a systematic review to describe impact on HRQoL based on different modalities of treatment for small urolithiases with a diameter smaller or equal to 10 mm. METHODS Electronic databases were searched with no language or date restrictions to identify studies which were included if they reported: adult patients (≥18 years old), renal or ureteral stone(s) confirmed on imagery, validated reporting of HRQoL, stone diameter equal or smaller than 10 mm undergoing active surveillance, medical expulsive therapy (MET), shockwave lithotripsy (SWL), or ureteroscopy (URS). RESULTS Of 672 citations, nine articles were eligible. Five studies (all ureteral) reported HRQoL according to medical stone management. Three of them found that HRQoL in MET patients was better than in active surveillance patients and two studies found no difference in HRQoL between MET and active surveillance groups. Four studies (three ureteral, one renal) reported HRQoL according to surgical stone management. Of the ureteral stone studies, two reported better HRQoL in URS patients than in SWL patients, while one study found no difference between URS and SWL groups. In the renal stone study, SWL patients had better HRQoL than URS patients. CONCLUSIONS Patients with urinary stones 10 mm or smaller have better HRQoL when treated with MET vs. active surveillance, when treated with SWL vs. URS for renal stones, and when treated with URS vs. SWL for ureteral stones. There is an important need for more studies on this topic.
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Affiliation(s)
- Nick Lee
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Patricia Nadeau
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Anis Assad
- Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Ben Chew
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Kate Penniston
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Naeem Bhojani
- Division of Urology, Department of Surgery, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
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Akpakli EA, Asante E, Kyei MY, Klufio K, Toboh B, Mensah JE. Analysis, treatment modality and demographic characteristics of urolithiasis patients visiting Korle-Bu Teaching Hospital in Ghana. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2024; 14:94-101. [PMID: 38486658 PMCID: PMC10936895 DOI: 10.4103/jwas.jwas_86_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/09/2023] [Indexed: 03/17/2024]
Abstract
Background Globally urolithiasis is on the rise and gradually becoming a public health concern due to the associated complications. This study reviewed the demographic characteristics, the chemical composition of stones, treatment modality and duration of hospitalisation of urolithiasis patients at Korle-Bu Teaching Hospital, Accra, Ghana. Materials and Methods This was a retrospective study conducted between March 2019 and April 2022. Data from consecutive patients treated for urolithiasis were used for this study. Data on demographic characteristics, stones chemical composition, urine factors, urolithiasis treatment modality and duration of hospital stay after therapy were collated and analysed using descriptive and inferential approaches. Results The age of the patients ranged from 2 to 75 years with a mean of 45 (±13.4). The predominant age group for stone formation was 30-39 years - 52(26.3%). Urolithiasis was common among patients in the formal employment sector: 81(40.9%). All stones had two or more chemical compositions, with the combination of calcium oxalate monohydrate, calcium oxalate dihydrate and uric acid being the predominant stone type: 88(57.5%). Ureteroscopy with semi-rigid and Percutaneous nephrolithotomy were the predominant treatment modalities: 105(53.0%) and 74(37.4%), respectively. Escherichia coli was responsible for most urinary tract infections in urolithiasis patients 8(4.0%) and the least duration of hospital stay after the procedure was associated with the use of semi-rigid ureteroscope as the treatment modality with a median duration of 2 days (1-2 days) with P < 0.0001. Conclusions Urolithiasis was predominant among professionals in the formal sector. All stones were mixed with Calcium oxalate monohydrate, calcium oxalate dihydrate, and uric acid combination being the majority. Ureteroscopy with semi-rigid and percutaneous nephrolithotomy were the common treatment modality.
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Affiliation(s)
| | - Emmanuel Asante
- Department of Surgery, University of Ghana Medical Centre, Accra, Ghana
| | | | - Kenneth Klufio
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Bernard Toboh
- Department of Surgery, Korle-Bu Teaching Hospital, Accra, Ghana
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Yamashita S, Inoue T, Kohjimoto Y, Hara I. Comprehensive endoscopic management of impacted ureteral stones: Literature review and expert opinions. Int J Urol 2022; 29:799-806. [PMID: 35475562 DOI: 10.1111/iju.14908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/10/2022] [Indexed: 11/30/2022]
Abstract
Treatment of urolithiasis, a benign disease, requires high efficacy and safety. Endoscopic treatment of impacted ureteral stones remains a challenging procedure for urologists, despite recent remarkable advances in surgical technology in treatment of urolithiasis. The success rate of endoscopic treatment in patients with impacted stones is reported to be lower than that in patients with nonimpacted stones. Moreover, the presence of stone impaction is associated with high rates of intraoperative and postoperative complications. The best management for patients with impacted ureteral stones should therefore be devised based on the latest knowledge and techniques. The present review focuses on the preoperative prediction of stone impaction, the safest and most effective endoscopic surgical procedures, and the most appropriate management for postoperative ureteral strictures. We overview comprehensive endoscopic management for impacted ureteral stones based on literature review and expert opinions.
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Affiliation(s)
| | - Takaaki Inoue
- Department of Urology, Hara Genitourinary Hospital, Kobe, Japan.,Department of Urology, Kobe University, Kobe, Japan
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, Wakayama, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, Wakayama, Japan
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Batra R, Batra P, Garg S, Yadav S. Evaluation of ureterorenoscopy with semirigid ureteroscope and laser lithotripsy as a treatment modality for upper ureteric stones less than 20 mm. JOURNAL OF MAHATMA GANDHI INSTITUTE OF MEDICAL SCIENCES 2021. [DOI: 10.4103/jmgims.jmgims_80_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Akpayak IC, Agbo CA, Nabasu LE. Retrograde ureteroscopy in the management of distal ureteric stones: A retrospective analysis of outcome and complications. Ann Afr Med 2020; 19:258-262. [PMID: 33243949 PMCID: PMC8015960 DOI: 10.4103/aam.aam_65_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Urinary stones affect 8%-15% of the world population. In Nigeria, contemporary reports have shown that the incidence of urinary stones is rising. The distal ureter has been described as the most common location of ureteric stones. This study seeks to review our experience in the ureteroscopic management of distal ureteric stones with a view to appraising the stone clearance rate and the complications seen in our patients. Patients and Methods This descriptive study reviewed the record of 21 patients, who had semirigid ureteroscopy and pneumatic lithotripsy for distal ureteric stone between October 2015 and September 2018. All patients had computed tomography urography preoperatively to locate the stone. Data on patients' demographics, indication for the surgery, location and size of stone, preoperative double-J (DJ) placement, postoperative DJ stent placement, intraoperative and postoperative complications, and status of stone clearance were retrieved and subjected to statistical analysis. Results The mean age of the patients was 37.95 ± 11.09 (range, 21-67) years. The mean stone size was 8.06 ± 2.87 mm with a range of 4.8 mm-15.0 mm. Out of the 21 patients, 20 (95.2%) had the procedure for recurrent ureteric colic and 1 (48%) was for hematuria. Four (19.0%) patients had DJ stent preoperatively, whereas 17 (81.0%) patients did not have. Fourteen (66.7%) patients had intraoperative ureteric dilatation. Postoperative DJ stent was placed in 17 (81.0%) patients, whereas 4 (19.0%) patients did not have. Three (14.3%) patients had mucosal flap, 6 (14.3%) had mucosal abrasion, 2 (9.5%) had bleeding, 1 (4.8%) patient had transient hematuria postoperatively, and 2 (9.5%) patients had urinary tract infection. Nineteen (90.5%) patients had complete clearance in a single surgery. Two (9.5%) patients had symptomatic residual fragments that required repeat ureteroscopy. Conclusion Our study has shown that ureteroscopy is a useful and safe technique in the removal of stones in distal ureter.
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Affiliation(s)
| | - Christian A Agbo
- Department of Surgery, Division of Urology, Jos University Teaching Hospital, Jos, Nigeria
| | - Lemech E Nabasu
- Department of Surgery, Division of Urology, Jos University Teaching Hospital, Jos, Nigeria
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Chunlin Y, Wanlin D, Jinhua D. Analysis of the efficacy of holmium laser and pneumatic ballistic in the treatment of impacted ureteral calculi. Medicine (Baltimore) 2020; 99:e21692. [PMID: 32899002 PMCID: PMC7478784 DOI: 10.1097/md.0000000000021692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
To explore the safety and effectiveness of ureteroscopic holmium laser lithotripsy (UHLL) and ureteroscopic pneumatic lithotripsy (UPL) in the treatment of impacted ureteral calculi (IUC).Clinical data of 280 patients in our hospital from April 2016 to May 2019 were retrospectively collected and analyzed, including 136 cases of UHLL group and 144 cases of UPL group. The general clinical data, operation time, intraoperative bleeding volume, hospital stay, stone-free rate (SFR), and surgical complications were collected and analyzed in 2 group.Compared with UPL group, the operation time of UHLL group was significantly reduced (27.25 ± 8.39 vs 34.32 ± 10.57, P < .05), but the hospitalization cost was significantly increased (9.25 ± 0.75 vs 8.24 ± 0.51, P < .05). In terms of total SFR, the UHLL group was significantly higher than the UPL group (93.38% vs 83.33%, P = .011). For proximal IUC, compared with the UPL group, the SFR of the UHLL group was significantly increased (88.33% vs 70.31%, P = 0.005). For distal IUC, there was no significant difference in SFR (97.37% vs 93.75%, P = .638) between the UHLL group and UPL group. There were no significant differences in the complications of local mucosal injury, hematuria, febrile urinary tract infection, ureteral perforation, and urinary sepsis in the 2 groups (P > .05). However, the UHLL group was significantly lower in stone residual rate than the UPL group (6.61% vs 16.67%, P = .001).This study found that UHLL and UPL are safe and effective in the treatment of IUC, but UHLL has the advantages of shorter operation time and high SFR in the treatment of IUC.
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Could ureteral wall thickness have an impact on the operative and post-operative parameters in ureteroscopic management of proximal ureteral stones? Actas Urol Esp 2019; 43:474-479. [PMID: 31155374 DOI: 10.1016/j.acuro.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 09/27/2018] [Accepted: 10/17/2018] [Indexed: 12/23/2022]
Abstract
AIM To evaluate the possible impact of stone impaction in terms of ureteral wall thickness (UWT) on the success and procedure related parameters of ureteroscopic management in proximal ureteral calculi. PATIENTS AND METHODS 82 patients with proximal ureteric stones were included and were divided into 2subgroups where UWT was> 5mm in 38 cases; and <5mm in 44 cases. Stone size, degree of hydronehrosis, diameter of proximal ureteral luz, UWT and patient's demographics were evaluated. Semi-rigid ureteroscopy with Ho-YAG laser was performed and the possible impact of UWT as an objective parameter for stone impaction on the success rates and procedure related parameters was evaluated. RESULTS Mean patient age and stone size values were 47.55±1.78 years and 8.17±0.29mm respectively. Regarding the impact of UWT value at the stone site for the parameters mentioned above stone free rates particularly at 1-week after the procedure was higher in group 2 and the rate of residual fragments as well as the need for double J stent placement was higher in group 1. Additionally, mean duration of the procedures was significantly longer in Group 1 during which pathologic alterations were significantly higher in ureteral wall at stone site were observed in these cases (P=.0243). CONCLUSIONS UWT may be used to predict the success of ureteroscopic management and other procedure related parameters for proximal ureteral stones in an effective manner. With this approach a more rational operative plan with higher success rates, limited complications and auxiliary procedures could be made.
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Özkaya F, Sertkaya Z, Karabulut İ, Aksoy Y. The effect of using ureteral access sheath for treatment of impacted ureteral stones at mid-upper part with flexible ureterorenoscopy: a randomized prospective study. MINERVA UROL NEFROL 2019; 71:413-420. [PMID: 31144488 DOI: 10.23736/s0393-2249.19.03356-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The number of the studies made on the efficacy of flexible ureteroscopy (FURS) with ureteral access sheath (UAS) for impacted ureteral stones is limited. The aim of our study was to compare the efficacy and reliability of FURS in treatment of mid-upper impacted ureteral stones in cases where access is used or not. METHODS Between January 2017 and June 2018, 131 adult patients who applied to our clinic with complaints of mid-upper impacted ureteral stones. Patients were randomized as group 1 (without UAS) and group 2 (with UAS) by means of a draw and assessed in terms of demographic features, stone size, stone localization, hydronephrosis grade, operation time, scope time, the need for additional surgery, hospitalization time and complications. RESULTS The mean age of the patients in group 1 was 45.01 years (19-76) and was 37.01 years (16-80) in group 2. Mean stone size was 9.04 mm2 and 9.77 mm2 in group 1 and 2, respectively. Additional treatment was required for 26 (42.6%) patients in group 1 and 8 (11.4%) in group 2. No major intraoperative and postoperative complications developed in both groups. Although bleeding as a postoperative complication rate was similar, fever (>38° C) and urinary tract infection were higher in group 1 than in group 2. CONCLUSIONS In the treatment of mid-upper impacted ureteral stones, using UAS during the application of FURS is an advantageous procedure due to shorter operation time, fever intraoperative stone migrations and the need for additional surgery, less postoperative infection.
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Affiliation(s)
- Fatih Özkaya
- Department of Urology, Faculty of Medicine, Ataturk University, Erzurum, Turkey -
| | - Zülfü Sertkaya
- Department of Urology, Dicle Memorial Hospital, Diyarbakır, Turkey
| | - İbrahim Karabulut
- Department of Urology, Erzurum Regional Training and Research Hospital, Health Science University, Erzurum, Turkey
| | - Yılmaz Aksoy
- Department of Urology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
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Elibol O, Safak KY, Buz A, Eryildirim B, Erdem K, Sarica K. Radiological noninvasive assessment of ureteral stone impaction into the ureteric wall: A critical evaluation with objective radiological parameters. Investig Clin Urol 2017; 58:339-345. [PMID: 28868505 PMCID: PMC5577330 DOI: 10.4111/icu.2017.58.5.339] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/25/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To determine the predictive value of certain radiological parameters for an objective asssessment of the presence of ureteral stone impaction. MATERIALS AND METHODS Seventy-nine patients with a single proximal ureteral stones were retrieved from the departmental database. Both clinical and particularly radiological data of all cases were well evaluated on this aspect. In addition to the time period between the first colic attack and definitive management; diameter of proximal ureter and renal pelvis, longitudinal and transverse stone size, Hounsfied unit (HU) of the stone and lastly ureteral wall thickness at the impacted stone site were all carefully evaluated and noted. RESULTS Patients had a single proximal ureteral stone. While mean age of the cases was ranged 20 to 78 years; mean stone size was 15.62±4.26 mm. Evaluation of our data demonstrated that although there was a statistically significant correlation between ureteral wall thickness and patients age, transverse diameter of the stone, ureteral diameter just proximal to the stone, renal pelvic diameter and the duration of renal colic attacks; no correlation could be demonstrated between patients sex and the HU of the stone. CONCLUSIONS Prediction of the presence and degree of proximal ureteral stone impaction is a challenging issue and our data indicated a highly significant correlation between ureteral wall thickness and the some certain radiological as well as clinical parameters evaluated which will give an objective information about the presence of impaction which may in turn be helpful in the follow-up and also management plans of such calculi.
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Affiliation(s)
- Ozlem Elibol
- Dr. Lütfi Kirdar Training and Research Hospital Radiology Clinic, Istanbul, Turkey
| | - Kadihan Yalcin Safak
- Dr. Lütfi Kirdar Training and Research Hospital Radiology Clinic, Istanbul, Turkey
| | - Ayse Buz
- Dr. Lütfi Kirdar Training and Research Hospital Radiology Clinic, Istanbul, Turkey
| | - Bilal Eryildirim
- Dr. Lütfi Kirdar Training and Research Hospital Radiology Clinic, Istanbul, Turkey
| | - Kutluhan Erdem
- Dr. Lütfi Kirdar Training and Research Hospital Radiology Clinic, Istanbul, Turkey
| | - Kemal Sarica
- Dr. Lütfi Kirdar Training and Research Hospital Radiology Clinic, Istanbul, Turkey
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Ceylan Y, Ucer O, Bozkurt O, Gunlusoy B, Mertoglu O, Zumrutbas AE, Yildiz G, Irer B, Muezzinoglu T, Demir O. The effect of SWL and URS on health-related quality of life in proximal ureteral stones. MINIM INVASIV THER 2017; 27:148-152. [DOI: 10.1080/13645706.2017.1350719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yasin Ceylan
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Oktay Ucer
- Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Ozan Bozkurt
- Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Bulent Gunlusoy
- Department of Urology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Oguz Mertoglu
- Department of Urology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ali Ersin Zumrutbas
- Department of Urology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Guner Yildiz
- Department of Urology, Dr Suat Seren Chest Diseases and Surgery Training, Research Hospital, İzmir, Turkey
| | - Bora Irer
- Department of Urology, Esrefpaşa Hospital, Izmir, Turkey
| | - Talha Muezzinoglu
- Department of Urology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Omer Demir
- Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
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Galal EM, Anwar AZ, El-Bab TKF, Abdelhamid AM. Retrospective comparative study of rigid and flexible ureteroscopy for treatment of proximal ureteral stones. Int Braz J Urol 2017; 42:967-972. [PMID: 27622276 PMCID: PMC5066893 DOI: 10.1590/s1677-5538.ibju.2015.0644] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 02/29/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We analyzed the outcome and complications of rigid (R-URS) and flexible (F-URS) ureteroscopic lithotripsy for treatment of proximal ureteric stone (PUS). SUBJECTS AND METHODS Retrospective data of 135 patients (93 males and 42 females) submitted to R-URS and F-URS for treatment of PUS in the period between July 2013 and January 2015 were investigated. (R-URS, group 1) was performed in 72 patients while 63 patients underwent (F-URS, group 2).We compared the 2 groups for success, stone characteristics, operative time, intraoperative and postoperative complications. RESULTS The overall stone free rate (SFRs) was 49/72 (68%) in group 1 and 57/63 (91%) patients in group 2, (P=0.005). The operative time was shorter in group 1 in comparison to group 2 with statistically significant difference (P=0.005). There was not any statistically significant difference between 2 groups in complication rate (P=0.2). Conclusıon: Both R-URS and F-URS could be a feasible option for treatment of PUS. R-URS is less successful for treatment of PUS and should be used cautiously and with availability of F-URS.
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Legemate JD, Wijnstok NJ, Matsuda T, Strijbos W, Erdogru T, Roth B, Kinoshita H, Palacios-Ramos J, Scarpa RM, de la Rosette JJ. Characteristics and outcomes of ureteroscopic treatment in 2650 patients with impacted ureteral stones. World J Urol 2017; 35:1497-1506. [PMID: 28321499 PMCID: PMC5613106 DOI: 10.1007/s00345-017-2028-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 02/18/2017] [Indexed: 12/23/2022] Open
Abstract
Purpose To describe stone-free rates and complications of ureteroscopic treatment for impacted compared with non-impacted ureteral stones and evaluate predictive variables for impaction. Methods The Clinical Research Office of the Endourological Society prospectively collected 1 consecutive year of data from 114 centers worldwide. Patients eligible for inclusion were patients treated with ureteroscopy for ureteral stones. Patient characteristics, treatment details, and outcomes were compared with regard to stone impaction. Logistic regression analyses were conducted to explore predictive variables for ureteral stone impaction and to analyse the effect of impaction on outcomes. Results Of the 8543 treated patients, 2650 (31%) had impacted and 5893 (69%) non-impacted stones. The stone-free rate was 87.1% for impacted stones, which is lower compared with 92.7% for non-impacted stones (p < 0.001). Intra-operative complication rates were higher for impacted stones (7.9 versus 3.0%, p < 0.001). Significantly higher ureteral perforation- and avulsion rates were reported in the impacted stone group compared with the non-impacted stone group. No association between stone impaction and post-operative complications could be shown. Female gender, ASA-score >1, prior stone treatment, positive pre-operative urine culture, and larger stones showed to be predictive variables for stone impaction. Conclusions Ureteroscopic treatment for impacted stones is associated with lower stone-free rates and higher intra-operative complication rates compared with treatment for non-impacted stones. The predictive variables for the presence of stone impaction may contribute to the identification of stone impaction during the diagnostic process. Moreover, identification of stone impaction may aid the selection of the optimal treatment modality. Electronic supplementary material The online version of this article (doi:10.1007/s00345-017-2028-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaap D Legemate
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands.
| | - Nienke J Wijnstok
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
| | - Tadashi Matsuda
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | - Willem Strijbos
- Department of Urology, Zuyderland Medisch Centrum Parkstad, Heerlen, The Netherlands
| | - Tibet Erdogru
- Department of Urology, Memorial Istanbul Atasehir Hospital, Istanbul, Turkey
| | - Beat Roth
- Department of Urology, University Hospital Bern, Bern, Switzerland
| | - Hidefumi Kinoshita
- Department of Urology and Andrology, Kansai Medical University, Osaka, Japan
| | | | | | - Jean J de la Rosette
- Department of Urology, AMC University Hospital, Meibergdreef 9, 1105 AZ, Amsterdam-Zuidoost, The Netherlands
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Hameed D, Safwat A, Osman M, Gadelmoula M, Kurkar A, Elgammal M. Outcome of ureteral distensibility on the success of ureteroscopy: A prospective hospital-based descriptive study. AFRICAN JOURNAL OF UROLOGY 2017. [DOI: 10.1016/j.afju.2016.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Liu C, Zhou H, Jia W, Hu H, Zhang H, Li L. The Efficacy of Percutaneous Nephrolithotomy Using Pneumatic Lithotripsy vs. the Holmium Laser: a Randomized Study. Indian J Surg 2016; 79:294-298. [PMID: 28827902 DOI: 10.1007/s12262-016-1473-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022] Open
Abstract
The objective of the study is to compare the efficacy of percutaneous nephrolithotomy using holmium laser vs pneumatic lithotripsy. From August 2010 to March 2014, 200 patients with double kidney and single kidney stones without previous operations or other diseases were randomized into two groups according to the type of lithotripter used: pneumatic (n = 100) and laser (n = 100). The preoperative, intraoperative, and post-operative follow-up findings were analyzed and compared. The average stone size was similar in both the pneumatic and holmium laser lithotripsy groups (202.8 ± 52.6 mm2 vs. 200.3 ± 50.8 mm2). No significant difference was found between the operation time for the two groups (55.9 ± 16.5 min vs. 62.4 ± 17.6 min). The concentrations of creatinine in both groups increased 2-24 h after the operation and decreased to a normal level 1-4 days after the operation in both groups. Renal diuretic scan revealed that the peak and the renal index were both abnormal after the operation but became normal 4 days after the operation in both groups. No significant difference of creatinine concentration or the diuresis renogram was observed between the two groups. However, two cases in the holmium laser group had almost lost the renal function of the operated kidney 1 year later. Both pneumatic and holmium laser lithotripsy can be associated with acute renal injury in some patients after the operation without any significant difference. However, some infrequent severe renal function damage in laser lithotripsy should be noted.
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Affiliation(s)
- Chaoying Liu
- Department of Urology, Chongqing Fifth People's Hospital, Chongqing, China
| | - Houyong Zhou
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Weisheng Jia
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Hua Hu
- Department of Urology, Chongqing Fifth People's Hospital, Chongqing, China
| | - Heng Zhang
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, Chongqing, China
| | - Longkun Li
- Department of Urology, Second Affiliated Hospital, Third Military Medical University, Chongqing, China.,Department of Urology, Xinqiao Hospital, Third Military Medical University, Chongqing, 400037 China
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Sarica K, Eryildirim B, Sahin C, Sabuncu K, Cetinel C, Narter F. Impaction of ureteral stones into the ureteral wall: Is it possible to predict? Urolithiasis 2015; 44:371-6. [PMID: 26662172 DOI: 10.1007/s00240-015-0850-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/17/2015] [Indexed: 12/01/2022]
Abstract
To determine the possible predictive value of certain acute phase reactants CRP and ESR as well as radiologic parameters on the degree of impaction in ureteral stones. A total of 80 adult patients with a single opaque proximal ureteral stone were evaluated. A non-contrast CT was performed in all cases and all possible radiologic predictive parameters calculated. Additionally, to outline the degree of impaction at the stone site, two serum acute phase reactants namely CRP and ESR levels were also assessed. Patients were divided into two groups as follows; Group 1 (n:42) patients with normal CRP levels and Group 2 (n:38) patients with elevated levels of CRP. The data obtained in the subgroups were first comparatively evaluated with radiological parameters and the possible correlation between CRP values and these parameters was well evaluated. While the serum CRP levels were normal in 42 cases, they were elevated in 38 cases. Evaluation of the data from CRP subgroups and radiologic parameters showed that elevated levels of serum CRP were closely related with mean values of ureteral wall thickness (UWT) as well as mean level of hydronephrosis with a statistically significant difference. Additionally, a correlation analysis between serum CRP levels and all other parameters mentioned above demonstrated a statistically significant correlation between UWT, degree of hydronephrosis and serum ESR values. Evaluation of serum CRP and ESR values could let us to predict the UWT, a parameter which is closely related with the degree of stone impaction.
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Affiliation(s)
- Kemal Sarica
- Dr. Lütfi Kirdar Training and Research Hospital Urology Clinic, Tecerdagi Cad. Yakutlar Sitesi G/11, Kartal, Istanbul, Turkey
| | - Bilal Eryildirim
- Dr. Lütfi Kirdar Training and Research Hospital Urology Clinic, Tecerdagi Cad. Yakutlar Sitesi G/11, Kartal, Istanbul, Turkey.
| | - Cahit Sahin
- Dr. Lütfi Kirdar Training and Research Hospital Urology Clinic, Tecerdagi Cad. Yakutlar Sitesi G/11, Kartal, Istanbul, Turkey
| | - Kubilay Sabuncu
- Dr. Lütfi Kirdar Training and Research Hospital Urology Clinic, Tecerdagi Cad. Yakutlar Sitesi G/11, Kartal, Istanbul, Turkey
| | - Cihangir Cetinel
- Dr. Lütfi Kirdar Training and Research Hospital Urology Clinic, Tecerdagi Cad. Yakutlar Sitesi G/11, Kartal, Istanbul, Turkey
| | - Fehmi Narter
- Dr. Lütfi Kirdar Training and Research Hospital Urology Clinic, Tecerdagi Cad. Yakutlar Sitesi G/11, Kartal, Istanbul, Turkey
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Chung DY, Cho KS, Lee DH, Han JH, Kang DH, Jung HD, Kown JK, Ham WS, Choi YD, Lee JY. Impact of colic pain as a significant factor for predicting the stone free rate of one-session shock wave lithotripsy for treating ureter stones: a Bayesian logistic regression model analysis. PLoS One 2015; 10:e0123800. [PMID: 25902059 PMCID: PMC4406693 DOI: 10.1371/journal.pone.0123800] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/06/2015] [Indexed: 11/21/2022] Open
Abstract
Purpose This study was conducted to evaluate colic pain as a prognostic pretreatment factor that can influence ureter stone clearance and to estimate the probability of stone-free status in shock wave lithotripsy (SWL) patients with a ureter stone. Materials and Methods We retrospectively reviewed the medical records of 1,418 patients who underwent their first SWL between 2005 and 2013. Among these patients, 551 had a ureter stone measuring 4–20 mm and were thus eligible for our analyses. The colic pain as the chief complaint was defined as either subjective flank pain during history taking and physical examination. Propensity-scores for established for colic pain was calculated for each patient using multivariate logistic regression based upon the following covariates: age, maximal stone length (MSL), and mean stone density (MSD). Each factor was evaluated as predictor for stone-free status by Bayesian and non-Bayesian logistic regression model. Results After propensity-score matching, 217 patients were extracted in each group from the total patient cohort. There were no statistical differences in variables used in propensity- score matching. One-session success and stone-free rate were also higher in the painful group (73.7% and 71.0%, respectively) than in the painless group (63.6% and 60.4%, respectively). In multivariate non-Bayesian and Bayesian logistic regression models, a painful stone, shorter MSL, and lower MSD were significant factors for one-session stone-free status in patients who underwent SWL. Conclusions Colic pain in patients with ureter calculi was one of the significant predicting factors including MSL and MSD for one-session stone-free status of SWL.
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Affiliation(s)
- Doo Yong Chung
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Gangnam Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hun Lee
- Department of Urology, Severance Check-Up, Yonsei University Health System, Seoul, Korea
| | - Jang Hee Han
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Hyuk Kang
- Department of Urology, Yangpyeong Health Center, Yangpyeong, Korea
| | - Hae Do Jung
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Kyou Kown
- Department of Urology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Won Sik Ham
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Severance Hospital, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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El-Qadhi M. Outcome of ureteroscopy for the management of distal ureteric calculi: 5-years’ experience. AFRICAN JOURNAL OF UROLOGY 2015. [DOI: 10.1016/j.afju.2014.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ureteral wall thickness at the impacted ureteral stone site: a critical predictor for success rates after SWL. Urolithiasis 2014; 43:83-8. [PMID: 25417717 DOI: 10.1007/s00240-014-0724-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/15/2014] [Indexed: 11/27/2022]
Abstract
The aim of the study was to determine the possible predictive value of certain patient- and stone-related factors on the stone-free rates and auxiliary procedures after extracorporeal shock wave lithotripsy in patients with impacted proximal ureteral calculi. A total of 111 patients (86 male, 25 females M/F: 3.44/1) with impacted proximal ureteral stones treated with shock wave lithotripsy were evaluated. Cases were retrieved from a departmental shock wave lithotripsy database. Variables analyzed included BMI of the case, diameter of proximal ureter and renal pelvis, stone size and Hounsfield unit, ureteral wall thickness at the impacted stone site. Stone-free status on follow-up imaging at 3 months was considered a successful outcome. All patients had a single impacted proximal ureteral stone. While the mean age of the cases was 46 ± 13 years (range 26-79 years), mean stone size was 8.95 mm (5.3-15.1 mm). Following shock wave lithotripsy although 87 patients (78.4%) were completely stone-free at 3-month follow-up visit, 24 (21.6%) cases had residual fragments requiring further repeat procedures. Prediction of the final outcome of SWL in patients with impacted proximal ureteral stones is a challenging issue and our data did clearly indicate a highly significant relationship between ureteral wall thickness and the success rates of shock wave lithotripsy particularly in cases requiring additional procedures. Of all the evaluated stone- and patient-related factors, only ureteral wall thickness at the impacted stone site independently predicted shock wave lithotripsy success.
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Adanur S, Aydin HR, Ozkaya F, Ziypak T, Polat O. Holmium laser lithotripsy with semi-rigid ureteroscopy: a first-choice treatment for impacted ureteral stones in children? Med Sci Monit 2014; 20:2373-9. [PMID: 25415256 PMCID: PMC4250031 DOI: 10.12659/msm.891173] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background We aimed to assess the effectiveness of semi-rigid ureteroscopy and holmium laser lithotripsy in the treatment of impacted ureteral stones in children. Material/Methods We evaluated a total of 32 children under the age of 18 years treated with ureteroscopic holmium laser lithotripsy for impacted ureteral stones between January 2005 and July 2013. Their stone-free state was defined as the absence of any residual stone on radiologic evaluation performed 4 weeks postoperatively. Complications were evaluated according to the modified Clavien classification. Result The mean patient age was 9.5±5.1 years (range 1–18 years). Seven (21.8%) of the stones were located in the proximal ureter, 9 (28.2%) were in the mid-ureter, and 16 (50%) were in the distal ureter. The mean stone size was calculated as being 10.46±3.8 mm2 (range 5–20). The stone-free rate was 93.75% (30/32 patients) following primary URS. Additional treatment was required for only 2 (6.25%) of the patients. After the procedure, a D-J stent was placed in all the patients. The total complication rate was 15.6% (5 patients). The 10 total complications in these 5 patients were 5 (15.6%) Grade I, 1 (3.1%) Grade II, 2 (6.25%) Grade IIIa, and 2 (6.25%) Grade IIIb. The mean follow-up period was 16.5 months (range 3–55). Conclusions For the treatment of impacted ureteral stones in children, holmium laser lithotripsy with semi-rigid ureteroscopy, with its low retreatment requirement and acceptable complication rates, is an effective and reliable method in experienced and skilled hands as a first-choice treatment approach.
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Affiliation(s)
- Senol Adanur
- Department of Urology, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Hasan Riza Aydin
- Department of Urology, Akçaabat Haçkalı Baba Hospital, Trabzon, Turkey
| | - Fatih Ozkaya
- Department of Urology, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Tevfik Ziypak
- Department of Urology, School of Medicine, Ataturk University, Erzurum, Turkey
| | - Ozkan Polat
- Department of Urology, School of Medicine, Ataturk University, Erzurum, Turkey
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Zhu H, Ye X, Xiao X, Chen X, Zhang Q, Wang H. Retrograde, antegrade, and laparoscopic approaches to the management of large upper ureteral stones after shockwave lithotripsy failure: a four-year retrospective study. J Endourol 2013; 28:100-3. [PMID: 23914784 DOI: 10.1089/end.2013.0391] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We compare the success rate and complications of retrograde ureteroscopy, laparoscopic ureterolithotomy, and percutaneous nephrolithotomy for the management of large upper ureteral stones. PATIENTS AND METHODS We retrospectively analyzed data from 73 patients with large (≥1 cm) upper ureteral stones at two institutions from January 2010 to May 2013. Twenty-two patients underwent retrograde ureteroscopy (group ULS), 30 patients underwent percutaneous nephrolithotripsy (group PCNL), and 21 patients underwent laparoscopic ureterolithotomy (group LS) for removal of upper ureteral stones. CT, intravenous urography, and ultrasound were performed 1 week and 1 month after surgical removal. RESULTS There were no significant differences in age, sex, or stone size among the three groups. Mean estimated blood loss and mean hospital stay showed a statistically significant difference among the three groups. Success rates in the PCNL, LS, and ULS groups were 100%, 90.5%, and 77.3%, respectively. The procedures of two patients in group LS were converted to open surgery because of the inability to find the ureteral stone in one patient and an adhesion too difficult to dissect in the other. The procedures of two patients in the ULS group were converted to LS, and those of three patients were converted to PCNL because of severe edema impaction at the site of the stone, a sharply angulated ureter obstruction, upward migration of the stone (seven patients), and intraoperative complications (two patients). CONCLUSIONS Percutaneous antegrade nephrolithotomy is a safe and effective minimally invasive treatment for patients with large upper ureteral stones that has several advantages over retrograde ureteroscopy and laparoscopic ureterolithotomy. Thus, percutaneous antegrade nephrolithotomy is recommended as a safe and good treatment option for large upper ureteral stones. A combined procedure (e.g., ureteral push-back and percutaneous removal) can be considered in some patients.
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Affiliation(s)
- Hongjian Zhu
- 1 Department of Urology, General Hospital of Armed Police Forces of China , Beijing, China
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Comparison of Ho:YAG laser and pneumatic lithotripsy in the treatment of impacted ureteral stones: an analysis of risk factors. Kaohsiung J Med Sci 2013; 30:153-8. [PMID: 24581216 DOI: 10.1016/j.kjms.2013.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 05/02/2013] [Indexed: 11/21/2022] Open
Abstract
The aim was to compare pneumatic and holmium:yttrium-aluminum-garnet laser in the treatment of impacted ureteral stones with different locations and to identify the risk factors for complications. Between March 2005 and November 2012, a total of 230 patients underwent ureteroscopic lithotripsy for impacted stones. Of the patients, 117 had pneumatic and 113 had laser lithotripsy for the fragmentation of the stones. Treatment outcomes based on evidence of being stone free were evaluated. Preoperative, operative, and postoperative follow-up findings were analyzed and compared. There was a difference between the two groups according to overall stone clearance rate (93.8% vs. 80.3%, p = 0.002). There was no statistically significant difference for distal location between the laser and pneumatic groups (96.8% vs. 91.7%, p =0.288). For 10 patients with intrarenally migrated stones who were managed with flexible ureterorenoscopy in the same session, laser lithotripsy was more successful than pneumatic for proximal ureteral stone (94.4% vs. 67.9%, p = 0.007). The overall complication rate was 26.1%. There was no statistically significant difference between the two groups (29% vs. 23%, p = 0.296). Multivariate logistic regression analysis revealed that the proximal location was a statistically significant parameter for the occurrence of complications in both groups (p = 0.001 for PL, p = 0.004 for laser). The pneumatic and holmium:yttrium-aluminum-garnet laser lithotripsy are effective in the treatment of distal impacted stones. Both treatments with semirigid ureteroscopy are acceptable for proximal impacted ureteral stones, but holmium laser lithotripsy has an advantage of use with flexible ureteroscope for intrarenally migrated stone.
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Mursi K, Elsheemy MS, Morsi HA, Ali Ghaleb AK, Abdel-Razzak OM. Semi-rigid ureteroscopy for ureteric and renal pelvic calculi: Predictive factors for complications and success. Arab J Urol 2013; 11:136-41. [PMID: 26558071 PMCID: PMC4443018 DOI: 10.1016/j.aju.2013.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 04/19/2013] [Accepted: 04/23/2013] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To analyse and compare the effect of stone site and size, method of lithotripsy, and level of experience on the results and complications of semi-rigid ureteroscopy for ureteric and renal pelvic stones. PATIENTS AND METHODS Between April 2010 and May 2011, 90 patients underwent 95 ureteroscopies, using 7.5- and 9-F semi-rigid ureteroscopes, with or without pneumatic or laser lithotripsy. The peri-operative findings were analysed and compared. RESULTS The mean (SD) longest diameter of the stones was 11.8 (4.5) mm. Laser lithotripsy was used in 32 cases and pneumatic lithotripsy in 26. There were complications in 35 procedures in the form of colicky pain (2%), haematuria (1%), stone migration (7%), equipment failure (5%), access failure (8%), mucosal injury (7%), fever (2%) and extravasation (3%).The calculi were successfully retrieved in 75 patients (83%). The success rate was 95%, 77%, 85%, and 53% in the lower, middle, upper ureter and renal pelvis, respectively. CONCLUSIONS Upper ureteric stones can be managed safely with the semi-rigid ureteroscope. Renal pelvic stones are associated with a lower success rate, and thus they were not a primary indication for ureteroscopic intervention. The secondary ureteroscopic management of renal pelvic stones improved the results of subsequent alkalinisation or shock-wave lithotripsy if they could not be eradicated completely. The failure rate was significantly small in lower ureteric stones and stones of <10 mm. Less experience, a stone size of >15 mm and patients ⩽2 years old were associated with more complications or a lower success rate. There was no significant difference in the success or complication rate between laser and pneumatic lithotripsy.
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Affiliation(s)
- Khaled Mursi
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Mohammed S Elsheemy
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | - Hany A Morsi
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
| | | | - Omar M Abdel-Razzak
- Department of Urology, Kasr Al-Ainy Hospitals, Cairo University, Cairo, Egypt
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Li H, Na W, Li H, Jiang Y, Gu X, Zhang M, Huo W, Kong X. Percutaneous nephrolithotomy versus ureteroscopic lithotomy for large (>15 mm) impacted upper ureteral stones in different locations: is the upper border of the fourth lumbar vertebra a good indication for choice of management method? J Endourol 2013; 27:1120-5. [PMID: 23514547 DOI: 10.1089/end.2012.0535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Abstract To determine whether treatment of patients with large (>15 mm) impacted upper ureteral stones depended on stone location, we prospectively evaluated the therapeutic outcomes, complications, safety, and effectiveness of percutaneous nephrolithotomy (PCNL) and ureteroscopic lithotomy (URSL) in patients with stones higher and lower than the upper border of the fourth lumbar vertebra. Of the 174 patients analyzed, 83 (47.7%) underwent PCNL and 91 (52.3%) underwent URSL; all patients were followed up 1 month later and every 6 months for 18 months. Mean operation time (108.76±19.36 vs. 63.56±16.38 minutes, p<0.05) and postoperative hospital stay (2.49±1.23 vs. 5.36±1.98 days, p<0.05) were significantly longer in the PCNL than in the URSL group. The overall stone-free rates after 1 month were 96.4% and 75.8%, respectively, differing significantly for stones higher (97.8% vs. 57.5%, p<0.05) but not lower (94.7% vs. 90.2%) than the upper border of the fourth lumbar vertebra. The stone-retropulsion rate of URSL differed significantly for stones higher and lower than the upper border of the 4th lumbar vertebra (47.5% vs. 9.8%, p<0.05). Postprocedural complication rates were comparable in the URSL and PCNL groups, although the rate of auxiliary or salvage procedures was higher in the URSL group. The efficiency quotients (EQ) for PCNL and URSL were 0.93 and 0.59, respectively, with EQs in the URSL group differing significantly for stones higher and lower than the upper border of the fourth lumbar vertebra (0.40 vs. 0.82, p<0.05). Our findings indicate that treatment of impacted upper ureteral stones is dependent on stone location relative to the upper border of the fourth lumbar vertebra. URSL is unsuitable for stones at a higher location, whereas URSL and PCNL were equally effective for stones at a lower location.
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Affiliation(s)
- Hai Li
- Department of Urology, China and Japan Union Hospital of Jilin University, Changchun, China
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Two-step minipercutaneous ureterolithotripsy under multimodal analgesia for complicated impacted calculi in proximal ureter. Urology 2013; 81:1147-52. [PMID: 23506727 DOI: 10.1016/j.urology.2012.11.080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 10/09/2012] [Accepted: 11/03/2012] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To suggest minipercutaneous ureterolithotripsy using the mininephroscope as an alternative process for impacted stones of the upper ureter because these stones can be challenging to treat and can produce severe symptoms. MATERIALS AND METHODS We report our results of cases in which the percutaneous approach using 2-step minipercutaneous ureteroscopy with the mininephroscope was used to achieve relief from the stone, with minimal anesthesia risks. A total of 54 patients (33 men and 21 women) presented with impacted stones in the proximal ureter. The mean stone size was 16.2 mm (range 10-21). All patients were treated with 2-step minipercutaneous antegrade ureterolithotripsy under multimodal analgesia. RESULTS The mean operative time was 49 minutes (range 40-110). Placement of the percutaneous drainage tube was quick and was performed with the patient under local anesthesia. The minipercutaneous session followed several days later, with the patient under multimodal anesthesia. The initial stone-free rate was 94%. The stone-free rate 2 months after the procedure was 100%. All procedures were well tolerated by the patients (group mean visual analog scale score 3.1 ± 0.7 standard deviation). No severe adverse events were noted. The mean hospital stay was 5.3 days (range 3-12). CONCLUSION In selected emergency cases of impacted proximal ureteral stones, the approach of the initial insertion of a nephrostomy tube followed by a second session of antegrade ureterolithotripsy using the mininephroscope is a safe and effective alternative treatment, especially, because it can be accomplished with minimal anesthesia requirements.
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Kamarulzaman MN. Comment on: Laparoscopic transperitoneal ureterolithotomy for large ureteric stone. Urol Ann 2012; 4:195-6. [PMID: 23248532 PMCID: PMC3519117 DOI: 10.4103/0974-7796.102679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mohd Nazli Kamarulzaman
- Urology Unit, Department of Surgery, Kulliyyah of Medicine, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
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Clavien Classification of Semirigid Ureteroscopy Complications: A Prospective Study. Urology 2012; 80:995-1001. [DOI: 10.1016/j.urology.2012.05.047] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 05/03/2012] [Accepted: 05/14/2012] [Indexed: 01/09/2023]
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Outcomes of Ureteroscopy for the Management of Impacted Ureteral Calculi With Different Localizations. Urology 2012; 80:811-5. [DOI: 10.1016/j.urology.2012.05.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 04/18/2012] [Accepted: 05/07/2012] [Indexed: 11/17/2022]
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28
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Binbay M, Tepeler A, Singh A, Akman T, Tekinaslan E, Sarilar O, Baykal M, Muslumanoglu AY. Evaluation of pneumatic versus holmium:YAG laser lithotripsy for impacted ureteral stones. Int Urol Nephrol 2011; 43:989-95. [PMID: 21479563 DOI: 10.1007/s11255-011-9951-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 03/21/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE We prospectively analyzed and compared the effectiveness and complications of pneumatic lithotripter with a holmium:yttrium-aluminum-garnet (Ho:YAG) laser for the ureterorenoscopic management of impacted ureteral stones. MATERIALS AND METHODS From January 2006 to January 2008, we performed retrograde endoscopic treatment in 288 patients with ureteral stones in our clinic. The patients with impacted stones were randomized into two groups according to the lithotripter used to fragment the stone: pneumatic (n = 40) and laser (n = 40). The preoperative, operative, and post-operative follow-up findings were analyzed and compared. RESULTS The average stone size was similar in both groups (118.8 ± 58.3 mm(2) vs. 110.7 ± 54.4 mm(2)). The calculi were located in the distal ureter in most of the patients in both groups (65% in pneumatic group and 52.5% in laser group). The operation time was significantly diminished in the laser group (P = 0.001). The stone-free rates after a single ureteroscopic procedure were 80 and 97.5% in the pneumatic and laser groups, respectively (P = 0.03). Auxiliary treatments were needed in seven patients in the pneumatic group, while only one patient in the laser group (P = 0.05) needed this treatment. After the additional procedures, a 100% success rate was achieved in both groups. The rate of double J stent insertion was significantly higher in the pneumatic group (P = 0.01). In the pneumatic group, four cases of stone up-migration and one case of post-operative stricture were seen, whereas only one case of stone up-migration was noted in the laser group. CONCLUSION Our comparative study has shown that the use of Ho:YAG as an intracorporeal lithotripter during ureteroscopic management of impacted ureteral stones is highly efficient with high success rates, regardless of the stone location.
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Affiliation(s)
- Murat Binbay
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey.
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